MEDICARE: PRESCOTTS LIMBS & BRACES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier	000080	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326075102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESCOTTS LIMBS & BRACES, INC.

Provider Business Mailing Address
First Line	:	6715 SAN PEDRO AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-7218
Country	:	US
Telephone Number	:	210-224-0726
Fax Number	:	210-341-3164

Provider Business Practice Location Address
First Line	:	6715 SAN PEDRO AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-7218
Country	:	US
Telephone Number	:	210-224-0726
Fax Number	:	210-341-3164

Authorized Official
Title or Position	:	OWNER/PRACTITIONER
Name	:	MR. GARY WAYNE PRESCOTT
Credential	:
Telephone Number	:	210-224-0726

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	09/16/2015

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